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Healthcare Fraud

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Page 57 of 126

Catch of the Week: ResMed Pays $37.5 Million to Settle Five Qui Tam Cases Alleging Kickbacks

Posted  01/16/20
Pizza cut into wedges
Sleep apnea equipment manufacturer ResMed agreed to pay $37.5 million to resolve allegations that it violated the False Claims Act and Anti-Kickback Statute by providing unlawful remuneration to durable medical equipment distributors, sleep labs, doctors, and other healthcare providers.  It seems that ResMed’s kickback schemes struck many people as wrong: the settlement resolves five separate cases brought by...

Tagged in: Anti-Kickback and Stark, Catch of the Week, FCA Federal, Healthcare Fraud, Medical Devices and DME, Multiple Whistleblowers and First-to-File, Whistleblower Case,

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January 16, 2020

Udaya Shetty, a psychiatrist in Virginia, was sentenced to over two years in prison and has agreed to pay over $1 million to the United States and the Commonwealth of Virginia to resolve allegations of submitting false claims to Medicare, Medicaid, and TRICARE.  Shetty was accused of billing for services that average about 40-60 minutes long, despite quadruple booking patients and only seeing them for about 5-10 minutes each.  The scheme began at his own practice, Behavioral & Neuropsychiatric Group, in 2013, and continued at a new practice, Quietly Radiant Psychiatric Services, in 2017.  As a result of his actions, government health programs were defrauded of more than $450,000.  USAO EDVA

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medicare, Other Government Health Programs,

January 16, 2020

A former pharmaceutical sales representative in Texas has been sentenced to 2.5 years in prison and ordered to pay $1,746,222 in restitution for participating in a healthcare bribery scheme from 2013 to 2014.  In return for receiving commissions from pharmacies and paying them to medical providers, Holly Blakely had submitted fraudulent prescriptions to two different compounding pharmacies on behalf of unsuspecting individuals, causing approximately $8.8 million in losses to private and government healthcare providers.  USAO WDTX

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Lack of Medical Necessity,

January 15, 2020

ResMed Corp. has agreed to pay $37.5 million to resolve five whistleblower-brought lawsuits alleging that the durable medical equipment (DME) manufacturer paid illegal kickbacks to suppliers, sleep labs, and other health providers, in violation of the Anti-Kickback Statute and False Claims Act.  $6.2 million of the settlement will be split amongst the whistleblowers, who had revealed that ResMed improperly provided or helped provide free or below cost call center services, patient outreach services, medical equipment and installation, and interest-free loans, in exchange for business.  DOJ; USAO EDNY; USAO NC; USAO NDIA; USAO SC; USAO SDCA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Medicaid, Medical Devices and DME, Medicare, Other Government Health Programs, Whistleblower Case, Whistleblower Rewards,

January 15, 2020

TMJ & Orofacial Pain Treatment Centers of Wisconsin has agreed to pay $1 million to settle a qui tam suit alleging submissions of false claims to Medicare and TRICARE.  According to the anonymous whistleblower, who will receive an undisclosed share of the settlement, TMJ billed the government health programs for prosthetic devices as if they had been fabricated by in-house surgeons, when in fact they had been fabricated by an outside laboratory.  USAO EDWI

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medical Devices and DME, Medicare, Other Government Health Programs, Provider Fraud, Upcoding, Whistleblower Case,

January 10, 2020

The owner of two Philadelphia-based testing laboratories has pleaded guilty and agreed to pay more than $77 million in restitution for participating in an illegal kickback scheme.  At his plea hearing, Ravitej Reddy admitted that his laboratories, Personalized Genetics, LLC and Med Health Services Management, LP, participated in a fraudulent scheme that took advantage of the labs' location in a high reimbursement area for Medicare cancer and pharmacogenetic testing the labs actually sent for testing to a laboratory that was located outside of the lucrative coverage area, because the labs lacked equipment to perform the tests themselves.  To secure the lab orders, Reddy admitted paying kickbacks to co-conspirators, including marketers that solicited specimens from Medicare beneficiaries, and a telemedicine practice that improperly authorized the tests without regard to medical necessity.  In addition to the restitution order, Reddy faces a maximum of 25 years in prison at his sentencing in February.  USAO WDPA

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Laboratory and IDTF, Lack of Medical Necessity, Medicare,

January 7, 2020

Behavioral Consulting of Tampa Bay (BCOTB) has agreed to pay $675,000 to settle claims alleging the autism service provider submitted false or fraudulent claims to TRICARE.  Following an audit by TRICARE's managed care support contractor, the United States launched an investigation into BCOTB's claims that revealed it had misrepresented the services that were provided, misrepresented the identity of service providers, requested payment on more units of time than reflected by records, and requested payment on services that were not substantiated by records.  USAO MDFL

Tagged in: FCA Federal, Healthcare Fraud, Misrepresentations, Other Government Health Programs, Provider Fraud,

January 6, 2020

A now defunct behavioral health clinic, Tree of Life, Inc., and its owners and operators, Ada and Victor Vidal, have agreed to pay $1.65 million to settle a whistleblower's claims that they violated the False Claims Act and Anti-Kickback Statute in claims to Pennsylvania's Medicaid program.  According to Erika Desjardins, the former Clinical Director, Tree of Life billed for therapy sessions where either the patient or therapist could not possibly have attended (in some cases due to a patient’s hospitalization or death), as well as therapy sessions provided by unqualified individuals.  To facilitate the fraud scheme, it created fake records, including forged signatures, and improperly paid a social worker for patient referrals.  As part of the settlement, the Vidals have been excluded from future participation in federal healthcare programs, and Desjardins, who had been fired for reporting internally, will receive $330,000 as their share of the recovery.  USAO EDPA

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Improper Medical Personnel, Medicaid, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

January 2, 2020

Two physicians in the San Diego area have agreed to pay nearly $1 million to settle allegations that they violated the False Claims Act by improperly billing Medicare for care provided by an uncredentialed physician.  The fraudulent conduct by Drs. Mark Smith and Fane Robinson of San Diego Retina Associates was revealed in a qui tam lawsuit by fellow ophthalmologist and former partner, Dr. Atul Jain, who will receive $170,778 of the settlement proceeds.  USAO SDCA

Tagged in: FCA Federal, Healthcare Fraud, Improper Medical Personnel, Provider Fraud, Whistleblower Case, Whistleblower Rewards,

December 30, 2019

A defense contractor accused of submitting false claims on a contract with the U.S. Army has agreed to pay $3 million to resolve its liability.  Kansas-based LaForge & Budd Construction Company, Inc., had been tasked with raising the elevation of a dam at the Fort Sill Army Post in Oklahoma.  Although the contract specified that satisfactory fill be used, LaForge defied this by using materials such as pieces of concrete, rebar, and rubble, and then represented to the Army that it had fully complied with the contract's terms and conditions.  USAO WDOK

Tagged in: Certifications, FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare,

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